Section 182-530-4100 - Medicaid preferred drug list (medicaid PDL)(1) The medicaid agency contracts with a vendor to perform systematic evidence-based drug reviews.(2) The pharmacy and therapeutics (P&T) committee or the drug use review (DUR) board reviews and evaluates the safety, efficacy, and outcomes of prescribed drugs, using evidence-based drug reviews.(3) The P&T committee makes recommendations to state agencies as to which drugs to include on the Washington PDL under chapter 182-50 WAC. The DUR board makes recommendations to the medicaid agency about which additional drug classes to include in the medicaid PDL.(4) The agency director or des-ignee makes the final selection of drugs or drug classes included on the medicaid PDL.(5) Drugs in a drug class on the medicaid PDL which are not on the Washington PDL are not subject to therapeutic interchange program (TIP) and dispense as written (DAW) rules under WAC 182-530-4150.(6) Drugs in a drug class on the medicaid PDL that have not been reviewed by the P&T committee or the DUR board may be treated as nonpreferred drugs and are not subject to DAW or TIP.(7) A nonpreferred drug is considered for authorization after the client has:(a) Tried and failed or is intolerant to at least one preferred drug; and(b) Met agency-established criteria for the nonpreferred drug.(8) Drugs in a drug class on the medicaid PDL may be designated as preferred drugs for special populations or specific indications.(9) Drugs in a drug class on the medicaid PDL may require authorization regardless of preferred or nonpreferred status.(10) When a preferred innovator drug or biological product on the medicaid PDL loses its patent, the agency may : (a) Designate an available, equally effective, generic equivalent, or biosimilar biological product as a preferred drug; and(b) Make the innovator drug or biological product non-preferred.Wash. Admin. Code § 182-530-4100
Amended by WSR 15-12-093, Filed 6/2/2015, effective 7/3/2015Amended by WSR 17-07-001, Filed 3/1/2017, effective 4/1/201711-14-075, recodified as § 182-530-4100, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.04.050, 74.09.700, 74.08.090, 2009 c 575. 10-06-011, § 388-530-4100, filed 2/19/10, effective 3/22/10. Statutory Authority: RCW 74.04.050, 74.08.090, 74.09.700, 2008 c 245. 08-21-107, § 388-530-4100, filed 10/16/08, effective 11/16/08. Statutory Authority: RCW 74.04.050, 74.08.090, 74.09.530, and 74.09.700. 07-20-049, § 388-530-4100, filed 9/26/07, effective 11/1/07.